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More health care letters

Sat., July 25, 2009

Tom Cambell thinks Obama has a lot to learn from the way we run our health care system. Agreed. He also said we need a system of co-payments. Disagree. Campbell is talking about a means test, which heaps shame on people whose only problem is lack of money. Health care is either universal or it is not. The obligation to make co-payments has, and we see it in America all the time, dissuaded people from seeking medical care and doing a self-inflicted kind of health care rationing. Obama's other idea, to treat employer-paid health insurance as a taxable benefit, is also flawed. Once again, universal mean what it says – no ifs, ands, or buts.

Larry Solway, Toronto

I've got another suggestion to increase the funding for health services. Statistics show that smokers and liquor users cost the health care system more. Why not levy a health tax on cigarette and liquor sales and direct this to Medicare.

Farrukh Saleem, Brampton

How distressing that a former deputy minister of health perpetuates myths about our health care system. Has Tom Campbell somehow missed the 30-odd years of evidence showing that user fees, or co-payments as he calls them, do little if anything to reduce costs and only penalize those who cannot afford to pay them?

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Mr. Campbell claims Canadians are overtaxed, but recent OECD data puts Canada's taxation rates in the bottom third of OECD countries, one reason why economists Hugh Mackenzie and Richard Shillington consider our health and social services "the best deal" most of us will ever get. It would be an even better deal if those tax dollars were used to reduce poverty – the only real way to prevent illness and sustain our health care system. And there is far more than 30 years of evidence that poverty is the primary determinant of health. That is the message that President Barack Obama needs to hear.

It's hard to know what is more shocking: that a person in such a senior position can make these claims in the face of the evidence or that he invokes Adam Smith during a market meltdown. Perhaps this helps us understand why effective reform of the health care system has been so difficult to achieve.

Bonita Heath, Toronto

Tom Campbell's article clearly brings into focus a major factor that contributes to Canadians' prime health care concern, i.e. "wait times." That factor is that general taxation alone is unable to adequately finance the demand (justified or unjustified) for health care services.

Here are the facts, based on the federal and Ontario government websites. From 2000-09, federal government revenue increased 42 per cent, Ontario revenue increased 59 per cent and Ontario health care expenses increased 100 per cent. Clearly the health care system is financially unsustainable from taxation alone. Regrettably there doesn't appear to be a political party or politician in Canada who is prepared to acknowledge this reality.

Without reducing services, Tom Campbell offers the only possible solution to the problem – i.e. Canadians pay more, according to their ability, thus assuring universality. A slight modification of Mr. Campbell's proposal would be for Canadians to pay at income tax time a premium and a portion of their health care costs for the previous year with the maximum payable in each case being calculated as an equitable percentage of income above basic living costs.

Ross McElroy, Retired Family Physician, Tavistock

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Tom Campbell points out how our medicare system is so much more successful in terms of cost, that the whole population is covered, and there's increased life expectancy compared to the U.S. system. Then he goes on to suggest not how we can do even better, but how we can do less. We have a problem that is on its way to being resolved, namely wait times. The problem he wants to resolve is cost. This is worthy of attention but to do so he recommends destroying the essence of the system: equal access to first class medicare.

Sure, we need to control costs but a two-tier system destroys the central tenet of medicare. If rich people can afford to pay more, what's wrong with their paying more taxes?

How about some really radical suggestions, such as discounts for non-smokers and for being a normal weight? Or incenting doctors for their success in keeping us healthy instead of the reverse? Or a charge against a deceased's estate for "heroic" efforts to extend life the last few months, with charges doubled for those estates worth more than $1 million?

We are deservedly proud of our medicare system. Let's bend our efforts to improve it, not to disassemble it.

Frank O'Hara, Toronto

Tom Campbell presents an objective and realistic outlook on comparing the Canadian and U.S. health care systems and offers good advice for both sides of the border. The Canadian system covers everyone, whereas 46 million Americans have no health care coverage, Canadians are healthier, live longer and we accomplish this while spending less than one-third per capita compared to the U.S. system. These are facts not anecdotal stories, such as those told by a disgruntled Canadian on U.S. TV ads. Fear mongering is easier to peddle than science so maybe the infomercial will sway a few of the uninformed. Most of us will stick with the facts thank you very much. Let's spend some more on our health care system and improve upon the superior results we have experienced for quite some time.

Tim Onyschuk, Burlington

As a Canadian, and former Torontonian living and teaching in California for the past 20 years, I am watching the renewed U.S. debate on health care with extreme interest. I am acutely aware of the benefits of the Canadian health care system. On a recent two-week visit to Canada, my American partner got to witness it first hand, as my 84-year-old mother fell and sustained head injuries and five broken vertebrae during our stay. My mother got immediate ambulance service, was CAT scanned within 15 minutes of arriving at a local hospital, spent eight days there, was CAT scanned a second time and then sent to a specialist in Hamilton, all without costing her a single cent.

By contrast, I continue to fight a bill for nearly $24,000 for an overnight stay in a California hospital last summer. Despite the fact that I have an employer health plan, and spend an additional $500 per month to supplement it, my insurance company denied the claim because the late night trip to the hospital with chest pains was an "unapproved visit."

As for Shona Holmes, who is currently traveling the U.S. with the sponsorship of the U.S. anti-health-care-reform lobby, I make two observations. First, the Canadian health care system may not be perfect. You will always find people in any system that falls through the cracks. But at least 100 per cent of Canadians are covered by a plan, as opposed to tens of millions of Americans who are not.

And second, when Ms. Holmes is finished traveling the U.S., bashing the Canadian health care system, she can return home and receive 100 per cent health care coverage until the day she dies. If she were American, she would find her coverage severely limited by a "pre existing condition."

Herb Proske, Southern California

These ongoing references and advertisements made by opponents to universal health in America that impugn health care in Canada are getting more and more tiresome.

I immigrated to Canada from the United States in 1996. I hold citizenship in both countries and receive the benefits of the Ontario provincial health care system. Since I am over 65, this is free and covers the cost of prescribed medications. The attention and advice I receive from my family doctor in Canada is equal to and sometimes better than what I received in the U.S. under health care systems and private health insurance provided by my employers.

It is difficult to draw conclusions about a universal health care system without looking carefully at differences between and within the systems, but here is a start:

According to the American Medical Association website, there are 430,794 primary care physicians for a population of 298,444,220; a ratio of 693 Americans per physician.

According to the Canadian health care website, there are 30,000 primary care physicians in Canada for a population of 33,098,932; a ratio of 1,103 Canadians per physician.

Despite this, the longevity of Canadians is greater than Americans. According to the CIA World Factbook 2009, Canada ranks 8th in the world with an average life span of 81.23 years whereas the United States is 50th with an average life span of 78.11 years. The average lifespan of Canadians is more than three years greater than that of Americans!

Richard Reinert, PhD, Toronto

Shona Holmes is not the only Waterdown woman to have been diagnosed with a brain tumor. But I disagree with her completely. I can't recall a single case of people dying because they have had to wait for a surgery to be scheduled, unless an organ donor couldn't be found.

In my experience, priority cases receive attention. I was diagnosed with a brain tumor and had surgery at Hamilton General four weeks ago to remove it. It took place in a reasonable amount of time and with an exceptional quality of care and to my utmost satisfaction.

From personal experience, I know our health care system works and if Holmes didn't have a problem with her physician what exactly are her motives for taking part in this media spectacle?

Marg Anyan, Waterdown

I am totally disgusted that Shona Holmes is going around the U.S. (probably being paid for it) putting down our health care system. My country is not perfect, but neither are others. This is so "not" patriotic. Canada has a good health care system, and she should be greatful for it, not ungrateful.

Marie-Joe Figueira, Milton

I have had a different experience with our health care system than Shona Holmes. From the time I had difficulty swallowing food to being diagnosed with esophageal cancer, having aggressive chemotherapy, major surgery, then more chemotherapy to "clean up," it took less than eight months.

I had a 10-centimetre tumor in my esophagus, and at that time the Canadian Cancer Society's webpage gave a 14 per cent survival rate for esophageal cancer. I was scared.

I had an excellent team of doctors and nurses at North York General Hospital. The doctors acted quickly, with expertise and kept me fully informed at every phase, which was very reassuring. I was also able to stay at home to receive strong moral support from my family and friends. All this played an important part in my recovery.

Now, 2 1/2 years after my surgery, a CT scan and check up this month showed no recurrence of cancer. I want to thank my government for universal health care, which has kept me alive and healthy.

Sol Hermolin, North York

I am a snowbird who enjoys the warm climate of Arizona and I talk to many Americans while there. If you live with them, you learn and are not influenced by one personal experience. It is unfortunate that Shona Holmes had to resort to getting medical care in the U.S. The good news is that she had the financial resourses to pay for such care. In the U.S., more than half of personal bankrupties are because of medical debt. U.S. citizens are losing their homes and entire life savings because of medical costs.

I have family living in the U.S. who incurred more than $9,700 in health care expenses last year even though they have a 10 per cent co-op plan with their employer. This did not include any major surgery. An American microbiologist told me she pays $6,000 per year with a $10,000 annual deductable for health care coverage. And any pre-existing condition is excluded.

A study done by Harvard revealed that heath care costs per capita are more than double in the U.S. than in Canada with no distinguishable outcomes. The study estimates that 30 per cent of health care costs are attributed to insurance company overhead and profit.

I am very happy to be a Canadian and firmly believe our system that provides health care coverage to every citizen is superior.

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